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Al-Zyoud NS, Hyassat MA, Bataineh OM. Jordanian mothers' perspectives on having their intellectually disabled daughters undergo hysterectomies: A qualitative study. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231192735. [PMID: 37497764 DOI: 10.1177/17446295231192735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
The current study aims to identify Jordanian mothers' perspectives on their intellectually disabled daughters receiving hysterectomies. A qualitative methodology was employed; for the study sample, twelve mothers were chosen using a snowballing technique. Semi-structured interviews were carried out, and thematic analysis was utilized. Two main themes arose from the data analysis process: the reasons why mothers made the decision for their daughters to have hysterectomies - which included fears about unwanted pregnancy and keeping family honor - despite this conflicting with their religious and cultural values, and their concerns about their daughters having hysterectomies. Based on these findings, some implications and suggestions for future research were provided.
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Affiliation(s)
- Nawaf S Al-Zyoud
- Department of Psychological Sciences, Qatar University, Doha, Qatar
| | - Mizyed A Hyassat
- Special Education Department, Al-Balqa Applied University, Al-Salt, Jordan
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Wilbur J, Poilapa R, Morrison C. Menstrual Health Experiences of People with Intellectual Disabilities and Their Caregivers during Vanuatu's Humanitarian Responses: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14540. [PMID: 36361421 PMCID: PMC9653728 DOI: 10.3390/ijerph192114540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Attention to menstrual health in humanitarian responses is increasing, but evidence related to people with intellectual disabilities and their caregivers is absent. This study begins to address that. We applied purposive sampling to select 17 women and girls (aged 15-31) with intellectual disabilities, their 17 caregivers in SANMA province, Vanuatu, and seven key informants. We used in-depth interviews, PhotoVoice and ranking, and observation and analysed data thematically using Nvivo 12. We found that caregivers wished to maintain the person's safety and privacy, especially when menstruating, which reduced evacuation options. People with intellectual disabilities support requirements sometimes increased after emergencies. This meant caregivers were less able to work and recover from disasters. Caregivers requested the distribution of more reusable menstrual materials and a greater choice, including adult-sized diapers for menstruation and incontinence. Key informants noted that menstrual health interventions must always be delivered to people with intellectual disabilities and their caregivers so that menstrual health knowledge and practices exist before emergencies. We found that men and women supported people with intellectual disabilities' menstrual health, thus challenging gendered assumptions about caregiving. Efforts to achieve menstrual health for this population within disaster preparedness plans must be included. If not, families will fall further into poverty every time a disaster hits Vanuatu.
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Affiliation(s)
- Jane Wilbur
- London School of Hygiene & Tropical Medicine, International Centre for Evidence in Disability, London WC1E 7HT, UK
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Qualitative Focus Groups with Professionals of Special Education and Parents of Young Females with Intellectual Disability Exploring Experiences with Menstrual Hygiene Management and the Trigger for the Non-Therapeutic Hysterectomy in Mexico. Healthcare (Basel) 2022; 10:healthcare10091690. [PMID: 36141302 PMCID: PMC9498658 DOI: 10.3390/healthcare10091690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
How primary carers, physicians, health education professionals, and others see or understand the subject of menstruation in women with intellectual disability (ID) is rooted in the socio-cultural context and in the socio-economic structures in which all of them live. The aim of this study was to explore how parents of young females with ID and special education professionals perceive and experience menstrual hygiene management, which coping strategies are applied; and what triggers the performance of a hysterectomy. A qualitative focus group study design was conducted with 69 parents and 11 special education professionals, in 14 schools and one Down syndrome clinic, in Mexico City. Data were analysed using the method of thematic analysis. The main concern of parents was how to cope with the underlying disease. They perceived menstrual bleeding positively. Their psychological distress had to do with the reproductive health of their daughters, with their wish to avoid pregnancy, and with their fear of death and leaving their daughters alone and helpless without them. None of them favoured hysterectomy. Medical indication of hysterectomy was identified as the trigger for its performance. There is an urgent need of policy development/review on best practices for hysterectomy in the females in question.
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Pradhan M, Dileep K, Nair A, Al Sawafi KM. Forced Surgeries in the Mentally Challenged Females: Ethical Consideration and a Narrative Review of Literature. Cureus 2022; 14:e26935. [PMID: 35989803 PMCID: PMC9378952 DOI: 10.7759/cureus.26935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/21/2022] Open
Abstract
Women with mental disabilities deal with menstrual problems like any other woman. The menstrual hygiene, discomfort, and sleep disturbance associated with menses make these women irritable, and their caregivers sometimes feel and decide on some unindicated surgeries like hysterectomy, sterilization, and abortion to save them from getting pregnant. While taking into consideration the burden on caregivers, complete informed choices to reach a decision are also important as these surgical procedures may do more harm than good. Early menopause happens when a hysterectomy is performed in young adults and can cause further deterioration of mental and physical health for example heart disease, and osteoporosis. Many agencies and law provide extended help and care to special children including education, and grooming which helps them achieve a life with minimum dependence. Before opting for treatment involvement of all the professionals associated with these people like psychiatrists, gynecologists, psychologists, involvement of human rights agencies, providing school education, and helping caregivers in providing care will bring some change.
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Altundağ S. Imparting genital hygiene skills to adolescents with intellectual disabilities attending a special education Centre: a quasi-experimental study on effect of short education. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:127-136. [PMID: 38456142 PMCID: PMC10916902 DOI: 10.1080/20473869.2022.2070421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/20/2022] [Indexed: 03/09/2024]
Abstract
Objective: The study aimed to evaluate the short-term effects of education given on genital hygiene to female students attending a special education center. Methods: We interviewed 52 girls selected by meeting the inclusion criteria, using a quasi-experimental method, the single group pre-test post-test model in a special education institution located in the Aegean region in Turkey. Results: The results of the programme the genital hygiene knowledge of the participants had significantly improved. Significantly positive changes were observed in genital hygiene knowledge compared to pre-training (p < .001). Conclusion: It is recommended that the program training and practices to be carried out simultaneously be implemented by healthcare professionals for adolescents with intellectual disability and their parents.
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Affiliation(s)
- Sebahat Altundağ
- Department of Pediatric Nursing, Pamukkale University Faculty of Health Sciences, Denizli, Turkey
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Wilbur J, Morrison C, Iakavai J, Shem J, Poilapa R, Bambery L, Baker S, Tanguay J, Sheppard P, Banks LM, Mactaggart I. "The weather is not good": exploring the menstrual health experiences of menstruators with and without disabilities in Vanuatu. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100325. [PMID: 35024657 PMCID: PMC8661049 DOI: 10.1016/j.lanwpc.2021.100325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Menstrual health is essential for gender equality and achieving the sustainable development goals. Though currently lacking, understanding and addressing menstrual health and social related inequalities requires comparison of experiences between menstruators with and without disabilities. METHODS We completed a mixed-methods population-based study of water, sanitation and hygiene, disability and menstrual health in TORBA and SANMA Provinces, Vanuatu. Methods included a census, nested case-control study, in-depth interviews (IDIs), focus group discussions (FGDs), PhotoVoice and structured observations. We undertook a population census of 11,000+ households and recruited 164 menstruators with and 169 without disabilities (aged 10-45) into a nested case-control study. 20 menstruators across both groups were selected for the qualitative component. FINDINGS Menstruators with disabilities were five times (adjusted Odds Ratio [aOR] 5.5, 95% Confidence Interval 1.8 - 16.5) more likely to use different bathing facilities to others in the household, nearly twice as likely (1.8, 1.1 - 3.1) to miss social activities, and three times (3.0, 1.6 - 5.7) more likely to eat alone during menstruation. Menstrual restrictions were widespread for all, but collecting water and managing menstrual materials was harder for menstruators with disabilities, particularly those requiring caregivers' support. These factors negatively impacted menstruators with disabilities' comfort, safety and hygiene, yet they reported less interference of menstruation on participation. INTERPRETATION Negative factors affecting all menstruators disproportionately impact those with disabilities, compounding existing inequalities. Menstruators with disabilities may have reported less interference because they are accustomed to greater participation restrictions than others. FUNDING Australian Government's Water for Women fund and public donations.
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Affiliation(s)
- Jane Wilbur
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK
| | - Chloe Morrison
- World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu
| | - Judith Iakavai
- Vanuatu Society for People with Disability, PO Box 373, Port Vila, Vanuatu
| | - Jeanine Shem
- World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu
| | - Relvie Poilapa
- World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu
| | - Luke Bambery
- World Vision Vanuatu, Rue Artoi M/S, P.O Box 247, Port Vila, Vanuatu
| | - Sally Baker
- Melbourne School of Population Health, University of Melbourne, 207 Bouverie St, Carlton, VIC 3053, Australia
| | - Jamie Tanguay
- Vanuatu National Statistics Office, Port Vila, Vanuatu
| | - Philip Sheppard
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK
| | - Islay Mactaggart
- International Centre for Evidence in Disability (ICED), London School of Hygiene & Tropical Medicine, Keppel Street, London WCE 7HT, UK
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Márquez-González H, Valdez-Martínez E, Bedolla M. Clinical, Epidemiologic and Ethical Aspects of Hysterectomy in Young Females With Intellectual Disability: A Multi-Centre Study of Public Hospitals in Mexico City. Front Public Health 2021; 9:746399. [PMID: 34869162 PMCID: PMC8637847 DOI: 10.3389/fpubh.2021.746399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Non-therapeutic hysterectomy has been performed to this day in Mexican women with intellectual disabilities (IDs), but the rationale for performing the procedure has been rarely submitted to clinical ethics committees. The objectives of the present research were to determine the frequency of hysterectomy and the clinical and epidemiologic characteristics that associated to the indication of hysterectomy in girls and young females with IDs and to analyse the emerging ethical issues related to the procedure. Materials and Methods: A medical chart review was conducted to identify female patients aged ≤ 25 years who had IDs based on anatomical pathologies and hospital records and underwent hysterectomy between January 2014 and December 2019 in nine high-concentration hospitals in Mexico City. Data were collected using a questionnaire developed ex professo and validated through a pilot study and analysed using the Statistical Package for the Social Sciences (SPSS) 21.0 software. Results: Information of 234 female patients with or without ID who were ≤ 25 years of age was reported by the departments of anatomical pathology and paediatrics. Of the patients, 184 (79%) were excluded because the information reported was found to be erroneous or incomplete during the medical records review. Most of the 50 emales included in the study had moderate ID (n = 23, 46%) followed by those with severe ID (n = 17, 34%). The mean age at hysterectomy was 15 ± 2.9 years. Prophylactic-total abdominal hysterectomy was the most frequently performed (n = 42, 84%). A concurrence was observed between the parental and medical reasons justifying hysterectomy. The most frequent reasons were fertility control (parents vs. physicians: 46 vs. 42%), management of menstrual hygiene (28 vs. 30%) and risk of sexual abuse (6 vs. 6%). Conclusion: This study showed that performing non-therapeutic hysterectomy is subject to the clinical judgement of physicians according to their perception of the patient's quality of life. Therefore, the ethical quality of the decision to perform the procedure in girls and young females resides in the ethical value of its consequences.
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Affiliation(s)
- Horacio Márquez-González
- Department of Clinical Research, Federico Gomez Children's Hospital, Mexico City, Mexico.,Congenital Heart Disease Department, Centro Medico Nacional Siglo XXI, Mexican Institute of Social Security, Cardiology Hospital, Mexico City, Mexico
| | - Edith Valdez-Martínez
- Medical Research Unit in Clinical Epidemiology, Health Research Council of the Mexican Institute of Social Security, Mexico City, Mexico
| | - Miguel Bedolla
- Alamo Colleges-Northwest Vista College, San Antonio, TX, United States
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Amir N, Mitra M, Leung K, Moore Simas TA. Complications following hysterectomy in women with intellectual and developmental disabilities. Disabil Health J 2021; 15:101213. [PMID: 34531173 DOI: 10.1016/j.dhjo.2021.101213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Limited data exist on complications following hysterectomy among women with intellectual and developmental disabilities (IDD). OBJECTIVE The objective was to assess the frequencies of postoperative complications in women with IDD following hysterectomy. METHODS The National Inpatient Sample from 2014 to 2017 was queried using codes from the International Classification of Disease 9th and 10th revisions to identify women over 15 years of age with a diagnosis of an IDD undergoing hysterectomy. Comparisons were made to women without IDD undergoing the same procedure. Logistic regression analysis was performed to examine between group differences in the frequency of clinical post-surgical complications while adjusting for potential confounding variables. RESULTS Of eligible women undergoing hysterectomy, 1,370 were identified as having IDD and 624,700 did not. Compared to controls, women with IDD were significantly younger (45 vs. 50 years, p < 0.001). Women with IDD were also more likely to have had governmental health insurance (83% vs. 34%, p < 0.001), an open hysterectomy approach (78% vs. 69%, p = 0.002), and longer hospital stays (4 vs. 3 days, p < 0.001). After adjusting for potential confounders, women with IDD had greater odds of postoperative urinary complications (OR 3.74, 95% CI 1.18-11.83) and complications related to decubitus ulcer formation (OR 8.97, 95% CI 2.10-38.36). CONCLUSIONS Women with IDD have increased odds having urinary and decubitus ulcer complications following hysterectomy, compared to women without IDD. These results inform surgical decision-making and anticipatory guidance for these women and their caregivers.
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Affiliation(s)
- Nili Amir
- UConn Health, Department of Obstetrics and Gynecology, 263 Farmington Avenue Farmington, CT 06030, USA; University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management Brandeis University, 415 South Street Waltham, MA, USA
| | - Katherine Leung
- University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, 55 Lake Ave N, Worcester, MA, 01655, USA; UMass Memorial Health Department of Obstetrics and Gynecology Memorial Campus, 119 Belmont Street, Jaquith Building Floor 2, Worcester, MA, 01605, USA
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Wilbur J, Scherer N, Mactaggart I, Shrestha G, Mahon T, Torondel B, Hameed S, Kuper H. Are Nepal's water, sanitation and hygiene and menstrual hygiene policies and supporting documents inclusive of disability? A policy analysis. Int J Equity Health 2021; 20:157. [PMID: 34238285 PMCID: PMC8268379 DOI: 10.1186/s12939-021-01463-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/29/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study assesses the inclusion of disability in Nepal's policy and guidance relevant to water, sanitation and hygiene (WASH), and menstrual hygiene management (MHM) in comparison to gender. We investigated both policy formulation and implementation, using the Kavrepalanchok district as a case study. MATERIALS AND METHODS We used the EquiFrame framework, adapted for disability and gender, and focusing on WASH and MHM. Ten Nepali policies and guidance documents were reviewed and scored for quality against the framework, which included 21 core concepts of human rights. We also interviewed key informants to consider the inclusion of disability in the implementation of MHM interventions. We applied stratified purpose sampling to 12 government officials and service providers working in Kathmandu and the Kavrepalanchock district; conducted in-depth interviews and analysed data thematically using Nvivo 11. RESULTS Disability was inadequately covered within the policy documents, and MHM policy commitments for disability were almost non-existent. Participation of people with disabilities in policy development was limited; within Kavrepalanchok, policy commitments were not implemented as intended and disability service providers were unable to allocate government resources. Inadequate data on disability and MHM resulted in limited professional understanding of the issues, as service providers had no training. A narrow WASH infrastructure approach to improving MHM for people with disabilities was prioritised. MHM interventions were delivered in schools; these failed to reach children with disabilities who are often out of school. Finally, there were indications that some caregivers seek sterilisation for people with disabilities who are unable to manage menstruation independently. CONCLUSION Though the Constitution of Nepal enshrines gender equality and disability inclusion, there are consistent gaps in attention to disability and MHM in policies and practice. These omit and exclude people with disabilities from MHM interventions. Investment is required to generate evidence on the MHM barriers faced by people with disabilities, which would then be drawn on to develop training on these issues for professionals to improve understanding. Subsequently, policy makers could include more concepts of human rights against disability in relevant policies and service providers could implement policy commitments as intended.
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Affiliation(s)
- Jane Wilbur
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Nathaniel Scherer
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Islay Mactaggart
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Govind Shrestha
- WaterAid Nepal, JM Road 10, Pabitra Tole Nakkhipot, 44700, Nepal
| | | | - Belen Torondel
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Shaffa Hameed
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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